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Wisconsin rates for HCPCS C1717

Brachytherapy source, nonstranded, high dose rate iridium-192, per source

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $5,623.41 / $5,623.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $223.87 / $309.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $346.74 / $346.74
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.78 / $223.87 / $616.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.78 / $223.87 / $870.96
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $58.88 / $85.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $346.74 / $549.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $933.25 / $1,230.27